CBT effective for insomnia but access to treatment needs to improve, says RCGP

Cognitive behavioural therapy (CBT) can improve insomnia but access to mental health treatment is still difficult to come by, the RCGP has said.

According to a new study by researchers at Queen’s University in Canada, patients suffering from insomnia should be recommended CBT as it has been proven to reduce symptoms of insomnia and maintain sleep improvements in subsequent years.

CBT for insomnia (CBT-I) typically comprises of stimulus control, where the patient learns to leave the bed when awake; sleep restriction, for example reducing time in bed to increase sleep pressure; cognitive therapy to challenge thoughts about sleep loss; and relaxation training.

In response to the study, RCGP chair Professor Helen Stokes-Lampard said while it’s positive that the study shows the benefits of CBT for treating insomnia without prescribing sleeping tablets, access to NHS CBT treatment is still hard to come by in certain communities up and down the country.

Professor Stokes-Lampard said: ‘Insomnia can cause huge distress and frustration for patients, and can have significant long-term health implications.

‘For many patients, sleeping tablets can seem like an obvious treatment option, but they are not usually effective for more than a few days, and GPs will only use them as a last resort after alternatives have been explored due to the risks of addiction and tolerance.

‘Cognitive behavioural therapy (CBT) tailored to insomnia has been a first-line treatment option for some time, and we know many patients have found it beneficial, so it is really positive that its effectiveness has been shown by this research today.

‘Unfortunately, access to treatments such as CBT in the NHS can be extremely difficult to come by in the community and are very variable across the country. This needs to be addressed, firstly by realising the pledge made in NHS England’s GP Forward View for every GP practice in the country to have access to one of 3,000 new mental health therapists by 2020/21 and by the provision of many additional psychologists trained to deliver CBT.’

The research looked at 13 published studies, reporting on the effectiveness of CBT-I and on sleep results. Studies looking at self-reported sleep showed medium to large positive effect from 4-6 sessions of CBT-I and studies evaluating post-CBT-I results showed improvements in sleep were maintained for 3-12 months post-treatment.

The study said: 'For the primary care provider, the results of this review provide evidence that CBT-I (group or individual) is effective at improving sleep onset and maintenance in primary care patients with chronic insomnia.'